NRSG 2300 Exam 5 Questions With Complete Solutions
_________ accounts for the largest percent of all birth defects
Correct Answer congenital heart defects (CHD)
_________ and _________ creates the first heart sound (S1).
The word "lub" is used to replicate its sound. S1 is usually heard
the loudest at the apical area. S1 is easily identifiable and serves
as the point of reference for the remainder of the cardiac cycle.
The intensity of S1 increases during tachycardias or with mitral
stenosis. In these circumstances, the AV valves are wide open
during ventricular contraction. The accentuated S1 occurs as the
AV valves close with greater force than normal. Similarly,
arrhythmias can vary the intensity of S1 from beat to beat due to
lack of synchronized atrial and ventricular contraction. Correct
Answer Tricuspid and mitral valve closure
_________ and _________ produces the second heart sound
(S2), commonly referred to as the "dub" sound. The aortic
component of S2 is heard the loudest over the aortic and
pulmonic areas. However, the pulmonic component of S2 is a
softer sound and is heard best over the pulmonic area. Although
these valves close almost simultaneously, the pulmonic valve
lags slightly behind the aortic valve. In some individuals, it is
possible to distinguish between the closure of the aortic and
pulmonic valves. When this situation occurs, the patient is said
to have a split S2. Normal physiologic splitting of S2 is
accentuated on inspiration and disappears on expiration. During
inspiration, there is a decrease in intrathoracic pressure and
subsequent increase in venous return to the right atrium and
ventricle. The right ventricle takes a little longer to eject this
,extra volume, which causes the pulmonic valve to close a little
later Correct Answer Closure of the pulmonic and aortic
valves
_________ can result from increases in cardiac output, increases
in peripheral resistance (constriction of the blood vessels), or
both. Increases in cardiac output are often related to an
expansion in vascular volume. Although no precise cause can be
identified for most cases of hypertension, it is understood that
hypertension is a multi factorial condition. Because hypertension
can be a sign, it is most likely to have many causes, just as fever
has many causes. For hypertension to occur there must be a
change in one or more factors affecting peripheral resistance or
cardiac output. In addition, there must also be a problem with
the body's control systems that monitor or regulate pressure.
Correct Answer Hypertension
_________ is an acute event, reflecting a breakdown of
physiologic compensatory mechanisms; hence, it is sometimes
referred to as acute decompensated heart failure. It can occur
following acute MI or as an exacerbation of chronic HF. When
the left ventricle begins to fail, blood backs up into the
pulmonary circulation, causing pulmonary interstitial edema.
This may occur quickly in some patients, a condition sometimes
called flash pulmonary edema. Pulmonary edema can also
develop slowly, especially when it is caused by noncardiac
disorders such as kidney injury and other conditions that cause
fluid overload. The left ventricle cannot handle the volume
overload, and blood volume and pressure build up in the left
atrium. The rapid increase in atrial pressure results in an acute
increase in pulmonary venous pressure, which produces an
,increase in hydrostatic pressure that forces fluid out of the
pulmonary capillaries an Correct Answer Pulmonary edema
_________ is reserved for the treatment of rest pain, severe and
disabling claudication, or when the limb is at risk for amputation
because of tissue necrosis. The choice of the procedure depends
on the degree, length, and location of the stenosis or occlusion
and whether there are single or multiple lesions. Other important
considerations are the overall health of the patient, the length of
the procedure, and anesthesia required. Correct Answer
Surgery
_________ is the product of cardiac output multiplied by
peripheral resistance. Cardiac output is the product of heart rate
multiplied by stroke volume. Each time the heart contracts,
pressure is transferred from the contraction of the myocardium
to the blood and then pressure is exerted by the blood as it flows
through the blood vessels. Correct Answer Blood pressure
_________ is thought to occur as a result of a complex
interaction between behavioral-social-environmental risks and
genetics. Behavioral-social-environmental risks may include
dietary habits, including limited consumption of vegetables,
fiber, fish fats, and potassium, and excessive intake of sodium;
obesity; poor physical fitness; and excessive alcohol intake.
Although single-gene mutations associated with hypertension
have been identified, most types of hypertension are thought to
be polygenic (ie mutations in more than one gene). The
tendency to develop hypertension can be inherited; however,
genetic profiles alone cannot predict who will and will not
develop hypertension. The role of genetics in hypertension is
, complex and not fully understood at the present time. To date,
over 1000 genetic variants have been identified that may
contribute to hypertension; however, collectively they explain
only about 6% of the Correct Answer Hypertension
_________ occurs late in diastole. It is heard just before S1 is
generated during atrial contraction as blood forcefully enters a
noncompliant ventricle. This resistance to blood flow is due to
ventricular hypertrophy caused by hypertension, CAD,
cardiomyopathies, aortic stenosis, and numerous other
conditions. "LUB lub-dub" is the mnemonic used to imitate this
gallop sound. S4, produced in the left ventricle, is auscultated
using the bell of the stethoscope over the apical area with the
patient in the left lateral position. There are times when both S3
and S4 are present, creating a quadruple rhythm, which sounds
like "LUB lub-dub DUB." During tachycardia, all four sounds
combine into a loud sound, referred to as a _________. Correct
Answer S4; summation gallop
_________ results in decreased blood ejected from the ventricle.
The decreased blood flow is sensed by baroreceptors in the
aortic and carotid bodies, and the sympathetic nervous system is
then stimulated to release epinephrine and norepinephrine. The
purpose of this initial response is to increase HR and
contractility and support the failing myocardium, but the
continued response has multiple negative effects. Sympathetic
stimulation causes vasoconstriction in the skin, GI tract, and
kidneys. A decrease in renal perfusion due to low CO and
vasoconstriction then causes the release of renin by the kidneys.
Renin converts the plasma protein angiotensinogen to
angiotensin I, which then circulates to the lungs. Angiotensin-
_________ accounts for the largest percent of all birth defects
Correct Answer congenital heart defects (CHD)
_________ and _________ creates the first heart sound (S1).
The word "lub" is used to replicate its sound. S1 is usually heard
the loudest at the apical area. S1 is easily identifiable and serves
as the point of reference for the remainder of the cardiac cycle.
The intensity of S1 increases during tachycardias or with mitral
stenosis. In these circumstances, the AV valves are wide open
during ventricular contraction. The accentuated S1 occurs as the
AV valves close with greater force than normal. Similarly,
arrhythmias can vary the intensity of S1 from beat to beat due to
lack of synchronized atrial and ventricular contraction. Correct
Answer Tricuspid and mitral valve closure
_________ and _________ produces the second heart sound
(S2), commonly referred to as the "dub" sound. The aortic
component of S2 is heard the loudest over the aortic and
pulmonic areas. However, the pulmonic component of S2 is a
softer sound and is heard best over the pulmonic area. Although
these valves close almost simultaneously, the pulmonic valve
lags slightly behind the aortic valve. In some individuals, it is
possible to distinguish between the closure of the aortic and
pulmonic valves. When this situation occurs, the patient is said
to have a split S2. Normal physiologic splitting of S2 is
accentuated on inspiration and disappears on expiration. During
inspiration, there is a decrease in intrathoracic pressure and
subsequent increase in venous return to the right atrium and
ventricle. The right ventricle takes a little longer to eject this
,extra volume, which causes the pulmonic valve to close a little
later Correct Answer Closure of the pulmonic and aortic
valves
_________ can result from increases in cardiac output, increases
in peripheral resistance (constriction of the blood vessels), or
both. Increases in cardiac output are often related to an
expansion in vascular volume. Although no precise cause can be
identified for most cases of hypertension, it is understood that
hypertension is a multi factorial condition. Because hypertension
can be a sign, it is most likely to have many causes, just as fever
has many causes. For hypertension to occur there must be a
change in one or more factors affecting peripheral resistance or
cardiac output. In addition, there must also be a problem with
the body's control systems that monitor or regulate pressure.
Correct Answer Hypertension
_________ is an acute event, reflecting a breakdown of
physiologic compensatory mechanisms; hence, it is sometimes
referred to as acute decompensated heart failure. It can occur
following acute MI or as an exacerbation of chronic HF. When
the left ventricle begins to fail, blood backs up into the
pulmonary circulation, causing pulmonary interstitial edema.
This may occur quickly in some patients, a condition sometimes
called flash pulmonary edema. Pulmonary edema can also
develop slowly, especially when it is caused by noncardiac
disorders such as kidney injury and other conditions that cause
fluid overload. The left ventricle cannot handle the volume
overload, and blood volume and pressure build up in the left
atrium. The rapid increase in atrial pressure results in an acute
increase in pulmonary venous pressure, which produces an
,increase in hydrostatic pressure that forces fluid out of the
pulmonary capillaries an Correct Answer Pulmonary edema
_________ is reserved for the treatment of rest pain, severe and
disabling claudication, or when the limb is at risk for amputation
because of tissue necrosis. The choice of the procedure depends
on the degree, length, and location of the stenosis or occlusion
and whether there are single or multiple lesions. Other important
considerations are the overall health of the patient, the length of
the procedure, and anesthesia required. Correct Answer
Surgery
_________ is the product of cardiac output multiplied by
peripheral resistance. Cardiac output is the product of heart rate
multiplied by stroke volume. Each time the heart contracts,
pressure is transferred from the contraction of the myocardium
to the blood and then pressure is exerted by the blood as it flows
through the blood vessels. Correct Answer Blood pressure
_________ is thought to occur as a result of a complex
interaction between behavioral-social-environmental risks and
genetics. Behavioral-social-environmental risks may include
dietary habits, including limited consumption of vegetables,
fiber, fish fats, and potassium, and excessive intake of sodium;
obesity; poor physical fitness; and excessive alcohol intake.
Although single-gene mutations associated with hypertension
have been identified, most types of hypertension are thought to
be polygenic (ie mutations in more than one gene). The
tendency to develop hypertension can be inherited; however,
genetic profiles alone cannot predict who will and will not
develop hypertension. The role of genetics in hypertension is
, complex and not fully understood at the present time. To date,
over 1000 genetic variants have been identified that may
contribute to hypertension; however, collectively they explain
only about 6% of the Correct Answer Hypertension
_________ occurs late in diastole. It is heard just before S1 is
generated during atrial contraction as blood forcefully enters a
noncompliant ventricle. This resistance to blood flow is due to
ventricular hypertrophy caused by hypertension, CAD,
cardiomyopathies, aortic stenosis, and numerous other
conditions. "LUB lub-dub" is the mnemonic used to imitate this
gallop sound. S4, produced in the left ventricle, is auscultated
using the bell of the stethoscope over the apical area with the
patient in the left lateral position. There are times when both S3
and S4 are present, creating a quadruple rhythm, which sounds
like "LUB lub-dub DUB." During tachycardia, all four sounds
combine into a loud sound, referred to as a _________. Correct
Answer S4; summation gallop
_________ results in decreased blood ejected from the ventricle.
The decreased blood flow is sensed by baroreceptors in the
aortic and carotid bodies, and the sympathetic nervous system is
then stimulated to release epinephrine and norepinephrine. The
purpose of this initial response is to increase HR and
contractility and support the failing myocardium, but the
continued response has multiple negative effects. Sympathetic
stimulation causes vasoconstriction in the skin, GI tract, and
kidneys. A decrease in renal perfusion due to low CO and
vasoconstriction then causes the release of renin by the kidneys.
Renin converts the plasma protein angiotensinogen to
angiotensin I, which then circulates to the lungs. Angiotensin-
